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Vaccination During Cancer Treatment

This is one part of a series on information about cancer patients and their risk of infection.

Should people with cancer get any vaccines?

It’s generally recommended that vaccines not be given during chemo or radiation treatments – the only exception to this is the flu shot. This is mainly because vaccines need an immune system response to work, and you may not get an adequate response during cancer treatment. There are also a few vaccines that contain live viruses, which can sometimes cause infections in people with weak immune systems.

The immune system is a complex system the body uses to resist infection by germs, such as bacteria or viruses. Cancer and cancer treatment can weaken a person’s immune system so that it won’t work as well as it should. (See Infections in People With Cancer to learn more about the immune system.)

Vaccines, which are also called immunizations or inoculations, are used to help a person’s immune system recognize and fight certain infections or diseases.

People with weak immune systems can get some vaccines, but they should not get any vaccines that contain live virus. Fatal infections have been caused by giving live-virus polio, measles, and smallpox vaccines to people with weak immune function.

Your cancer doctor (oncologist) should tell you about any vaccines that might help you. Be sure to talk to your cancer doctor before you or anyone you spend a lot of time with (such as your children) get any vaccines.

It’s important to know which vaccines are safe for people with weak immune systems. We will talk about some of the most common vaccines here.

    Be sure to talk to your cancer doctor before you or anyone you spend a lot of time with gets any vaccines.

Common vaccines

Flu shots

The flu shot is given to reduce your risk of getting influenza (the flu). It’s made with dead flu viruses and is safe for people with cancer.

The flu shot may be given at least 2 weeks before chemo or between chemo cycles. It can be given 6 months after a bone marrow or stem cell transplant. A different type of flu shot is given each year.

Flu-mist®, the nasal mist version of the flu vaccine, contains a weakened version of the live virus. People with cancer should not get the nasal mist flu vaccine. Family members of a person with cancer can safely get the nasal spray unless the patient has a severely weak immune system and/or is being cared for in a germ-protected area. For example, household members should not get the nasal mist vaccine if a family member has recently had a stem cell or bone marrow transplant.

For more on this, see Should I Get a Flu Shot?

MMR (Measles-Mumps-Rubella)

This vaccine is used to protect people from 3 viral diseases: measles, mumps, and rubella.

People who have weak immune systems should not get the MMR vaccine because it contains live virus. But it’s safe for other household members to get it.

After exposure to measles: If the person being treated for cancer is exposed to someone with measles, let the doctor know right away. Sometimes, measles immune globulin (a blood product that contains antibodies to the measles virus) can be given to help fight the measles infection before it starts.

Pneumococcus (pneumococcal pneumonia)

This vaccine can help people with weak immune systems fight off serious lung, blood, or brain infections caused by certain bacteria.

Your doctor may recommend one or more doses of the pneumococcal vaccine, depending on your age and health.

If you’re going to have your spleen removed, you’ll be given this vaccine before surgery (at least 2 weeks before).

Most adults with long-term health problems (like cancer) get the Pneumovax® (or PPV-23) vaccine.

Children and those with recent bone marrow/stem cell transplants may get a different vaccine (called PCV or Prevnar 13), but may then need to get the PPV-23 vaccine about 8 weeks later.

Polio vaccine

This vaccine is used to prevent polio, a viral infection linked to severe illness and physical disability. Since the vaccine came out in 1955, polio has become rare in the US.

Children who have weak immune systems, as well as their siblings and others who live with them, only should get inactivated polio virus vaccines. Most doctors in the United States use only the inactivated polio vaccine, but you should ask to be sure. The older oral polio virus vaccine (which is taken by mouth) contains a live virus. People who get the live virus vaccine can pass the virus on to people with weak immune systems.

Varicella (chickenpox)

This vaccine is called Varivax®. It’s intended to prevent chickenpox in people who have never had it. It’s given only to people whose blood tests show they do not have immunity to the varicella zoster virus (VZV).

This is another live virus vaccine. It should not be given to people with weak immune systems, or to people with leukemia, lymphoma, or any cancer of the bone marrow or lymphatic system unless it’s treated and under control. It’s OK for household members of the person with weak immunity to get the varicella vaccine.

If you’re exposed to chickenpox: A person with weak immunity who has been around someone with chickenpox should call the doctor right away. They may need VZV immune globulin (a blood product that contains antibodies to VZV) to help fight the virus. It must be given within 3 to 5 days of exposure. Cancer treatment may be stopped and restarted after the end of the VZV incubation period (this is the time it takes to see if you get sick, usually about 21 days). If a person with cancer has signs of VZV infection, the doctor may hold cancer treatment that causes immune suppression until scabs have formed.

Varicella zoster (shingles)

The shingles vaccine is called Zostavax®. It’s given to adults age 60 and older who have had chickenpox to help prevent shingles or make symptoms of shingles less severe.

This is a live virus vaccine that should not be used in people with weak immune systems. It should not be given to people getting chemo or radiation treatments, or those taking any drug that suppresses the immune system.

People who have had stem cell transplants must wait at least 2 years after the transplant to take this vaccine.

Talk to your doctor before you or anyone in your household gets this vaccine.

To learn more

From your American Cancer Society

Here is more information you might find helpful. You also can order free copies of our documents from our toll-free number, 1-800-227-2345, or read them on our website, www.cancer.org.

More on infection

Infections in People With Cancer

Preventing Infections in People With Cancer

Causes (Germs) and Treatment of Infections in People with Cancer

Vaccinations and cancer

Should I Get a Flu Shot?

Smallpox Vaccine and Cancer

Books

Your American Cancer Society also has books that you might find helpful. Call us at 1-800-227-2345 or visit our bookstore online at cancer.org/bookstore to find out about costs or to place an order.

National organizations and websites*

Along with the American Cancer Society, other sources of information and support include:

Centers for Disease Control and Prevention (CDC)
Toll-free number: 1-800-232-4636 (1-800-CDC-INFO)
TTY: 1-888-232-6348
Website: www.cdc.gov

    Offers reliable information on vaccines as well as infections, chronic diseases, and other health information (also offered in Spanish)

National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
TTY: 1-800-332-8615
Website: www.cancer.gov

    Offers information on cancer and its treatment, a drug dictionary of common medicines used in cancer treatment, and coping with cancer (also offered in Spanish)

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

Centers for Disease Control and Prevention. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2011;60(RR02),1-60. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm?s_cid=rr6002a1_e on January 15, 2015.

Centers for Disease Control and Prevention. Polio Vaccination. Accessed at www.cdc.gov/vaccines/vpd-vac/polio/default.htm on January 27, 2015.

Centers for Disease Control and Prevention. Post-exposure Varicella Vaccination. Accessed at www.cdc.gov/vaccines/vpd-vac/varicella/hcp-post-exposure.htm on January 28, 2015.

Centers for Disease Control and Prevention. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2013;62(RR04):1-34. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm on January 15, 2015.

Centers for Disease Control and Prevention. Shingles Vaccination: What You Need to Know. Accessed at www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm on January 28, 2015.

Centers for Disease Control and Prevention. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2012;61(40):816-819. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm on January 15, 2015.

Centers for Disease Control and Prevention. Vaccine Information Statements (VIS). Pnuemococcal Polysaccharide VIS. Accessed at www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.html on January 15, 2015.

Ljungman P, Cordonnier C, Einsele H, et al. Vaccination of hematopoietic cell transplant recipients Bone Marrow Transplantation. 2009;44,521-526.

National Comprehensive Cancer Network. Prevention and Treatment of Cancer-Related Infections. V.2.2014, 8/11/14 Accessed at www.nccn.org/professionals/physician_gls/pdf/infections.pdf on January 27, 2015.

Centers for Disease Control and Prevention. Varicella Vaccination Recommendations for Specific Groups. Accessed at www.cdc.gov/vaccines/vpd-vac/varicella/hcp-rec-spec-groups.htm on January 28, 2015.

National Comprehensive Cancer Network. Prevention and Treatment of Cancer-Related Infections. V.2.2014, 8/11/14 Accessed at www.nccn.org/professionals/physician_gls/pdf/infections.pdf on January 15, 2015.


Last Medical Review: 02/25/2015
Last Revised: 02/25/2015